Peptic Ulcers

The stomach normally protects itself from being digested by its own enzymes, or burnt by its corrosive hydrochloric acid, by secreting sticky, neutralising mucus that clings to the stomach walls. If this layer becomes damaged and digestive acid attacks the lining of the digestive tract you can get peptic ulcers. They can occur anywhere in the upper intestinal tract, but they are usually found in the stomach or the first few inches of the upper intestine (the duodenum).

These types of ulcers are called gastic ulcers when they are found in the stomach lining
and duodenal ulcers when they occur in the duodenum.

What are the symptoms of peptic ulcers?

The most common symptom of a peptic ulcer is pain felt in the upper part of the abdomen. The symptoms are often strongest in the early hours of the morning and are usually quickly relieved by a milky drink, anti-acid tablets or mixtures. The symptoms will probably come and go – you may have good periods lasting a few weeks, interspersed with bad periods when you get pain every day.

The stomach and duodenum protect themselves from being damaged by digestive acids by secreting a layer of protective mucus. When the balance between the mucus on the stomach walls and the digestive juices breaks down, a peptic ulcer may occur.
The most common reason the balance between the mucus on the stomach wall and the digestive juices breaks down is infection by the bacterium Helicobacter pylori.

What is helicobacter pylori?

While doctors have known for years that acid is an important cause of peptic ulcers, it is now understood that, in most cases, infection of the stomach lining with a bacterium called Helicobacter pylori (H. pylori) usually makes the stomach and duodenum more likely to ulcerate.
Almost 40% of the population is thought to have the infection H. pylori, but only 10% of these go on to develop a peptic ulcer.

H.pylori infection is thought to happen early in life, passed on from other members of the family. It is thought to be transmitted by close contact and to be more common in large families sharing a small house. It is not known exactly how it is passed on. The H. pylori bacterium conceals itself in the mucous lining in the lower half of the stomach and can cause thinning of the lining of the stomach allowing acid to penetrate. It also stimulates the stomach into making more acid. 

H. pylori infection can work in combination with gastric acid, your genetic background, your use of aspirin or drugs for arthritis, and cigarette smoking to cause ulcers of the stomach or duodenum.
However, most people infected with H. pylori will suffer no symptoms from it for their entire lives.

Other causes of peptic ulcers

People who have arthritis are affected by hormone-like chemicals in the body called prostaglandins. These chemicals cause the painful swelling and limitation of movement. However, prostaglandins also act to protect the lining of the stomach from injury by a wide variety of chemical agents, including the stomach’s own acid secretions. 

Non-steroidal anti-inflammatory drugs (NSAIDs) are used to treat arthritis by blocking prostaglandin action. This relieves joint pain and swelling, painful muscles and general pain, but it can also inhibit the stomach’s production of prostaglandins. Prostaglandins are needed in the stomach to maintain the mucous protective layer of the stomach and the gut. The NSAIDs weaken the protection of the stomach and this means the stomach acid and gastric juices can then cause peptic ulcers.